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Infection control for house officers at the Omaha VA Medical Center

Guidelines on infection control practices, equipment availability, and precautions at Omaha VA Medical Center based on CDC guidelines. Includes information on standard precautions, personal protective equipment, transmission-based precautions, and employee health issues.

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Infection control for house officers at the Omaha VA Medical Center

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  1. Infection control for house officers at the Omaha VA Medical Center Infection Control Practitioner Pager 13-485 ext. 3319 MRSA Prevention Coordinator Pager 13-323 ext. 4226 Hospital Epidemiologist Ext. 5606

  2. Omaha VA uses • Standard and Transmission-Based Precautions • Based on current guideline of the Centers for Disease Control and Prevention (CDC)

  3. Standard Precautions Protective barriers for ALL potential contact with: • All body fluids • Blood • All secretions • All excretions (except sweat) • Mucus membranes • Non intact skin

  4. Follow CDC 2002 hand hygiene guideline • No artificial nails, no chipped nail polish • Natural nail no longer than 0.25 inch • Wash hands with antimicrobial soap and water if visibly soiled or after caring for Clostridium difficile patients • Hand hygiene before and after patient contact, including after removal of gloves. Generally use alcohol handrub.

  5. Personal Protective Equipment (PPE) • What is available for your use? • Surgical masks • N-95 respirators (must be fit tested) • Gloves • Gowns • Eye protection

  6. Alcohol dispensers often near sinks & in every patient room

  7. Purell alcohol handrub

  8. Transmission based Precautions • Contact • Enhanced contact • Airborne • Droplet

  9. Contact precautions • Examples of Diseases in this category: • Drug-resistant organisms (eg MRSA, VRE) • SARS (also needs airborne precautions, eye protection)

  10. Contact precautions includes • Gown • Gloves • Hand hygiene • Dedicated equipment in the room (including stethoscope, blood pressure cuff) • Terminally clean room on discharge of patient from the room

  11. Isolation Cart

  12. Find a gown in an isolation cart

  13. Remove gown from cart

  14. Put on the gown, fasten-ing it in back

  15. Remove it after seeing the patient, turning it inside-out

  16. Place the used gown in the trash can

  17. Enhanced contact precautions • Examples of diseases in this category: • Clostridium difficile • Norovirus

  18. Actions: Enhanced contact precautions • Disinfect hands with antimicrobial soap and water (rather than alcohol gel) • Housekeeping staff use special cleaning methods involving bleach

  19. Airborne precautions • Fit-tested N95 mask • Room with negative air flow • Door closed

  20. Airborne Precautions • Examples of Diseases in this category: • Tuberculosis • Varicella • Measles • SARS (also needs contact precautions and eye protection)

  21. Common questions on airborne precautions: PPD • Q. “My patient has a positive tuberculin skin test (PPD test). Is this an indication for airborne precautions?” • A. No, only patients suspected of having active tuberculosis or proven to have active tuberculosis need airborne precautions.

  22. Common questions on airborne precautions: AFB • Q. “My patient has a laboratory test showing acid-fast bacilli (AFB) in the sputum. Does this mean the patient has tuberculosis?” • A. Not always. So-called atypical mycobacteria that are not causing tuberculosis can result in a lab report of AFB in the sputum and isolation is not indicated.

  23. Rooms for airborne precautions • 8 rooms available (includes 2 each in Emergency, ICU, 6E, and 7E) • Specially equipped to maintain negative flow • Reduces risk of pathogens drifting in air currents from infected patient to other patient rooms

  24. Check alarm outside negative air flow room • Alarm should be off with the door closed • If not, contact nurse

  25. Droplet precautions • Regular mask • Door may be open or closed for known or suspected

  26. Droplet Precautions • Examples of disease in this category: • Influenza • Pertussis • Neisseria meningitidis

  27. Employee Health Issues • Blood and body fluid exposure • Immediately notify supervisor • Immediately call Occupational Health (5825) during day hours or go to Urgent Care area after hours • Do so immediately since post exposure prophylaxis for HIV should be started, ideally within an hour • FREE influenza vaccine provided for all • Tuberculin skin test annually at host institution: CUMC or UNMC • Hepatitis B vaccine at host institution

  28. All blood and body fluid exposures are important • Sharps Injuries • Needle stick • Scalpel cut • Pipette break • Any injury that breaks the skin in the presence of body fluids • Mucous membrane exposure

  29. If a Blood Exposure Occurs: • Clean the exposed area with soap and water. For exposed mucous membranes, flush with water. DO NOT use bleach or surface disinfectants. • Report incident to supervisor immediately. • Report to Employee Health or Urgent Care area as previously described. • Fill out an Incident Report via the electronic reporting system - ASISTS

  30. Follow-up of blood or body fluid exposure • Follow-up after initial visit to Urgent Care • Occupational health nurse practitioner • Call 3209 to schedule visit

  31. Safety needles can prevent some blood exposures Be sure to use these devices correctly.

  32. Sharps disposal containers in each room

  33. Needle/Sharps Disposal • DO activate safety device • DO locate the disposal container closest to your work area • DO look to be sure that the opening of the box is clear of sharps • Do NOT recap by hand • Do NOT bend, clip or break

  34. Check to be sure disposal box is not overfilled

  35. Aims of OSHA bloodborne pathogens standard • To protect employees from • Occupational exposure to blood or other potentially infectious materials • Transmission of bloodborne diseases

  36. Bloodborne diseases of concern • Human immunodeficiency virus (HIV) • Hepatitis B (HBV) • Hepatitis C (HCV)

  37. Transmission in the workplace occurs by: • Parenteral Exposure • Needle stick, blood transmission • Mucous Membrane Exposure • Mouth, eyes • In the community, they may be transmitted through IV drug use and from mother to baby.

  38. Human Immunodeficiency Virus (HIV) • Virus that causes AIDS • Attacks the immune system • May be no obvious signs of infection • Can transmit virus before illness known

  39. Hepatitis B (HBV) • Symptoms if liver damage develops: • Poor appetite • Fatigue • Abdominal discomfort • Jaundice • 125,000 people infected yearly in US • 5-10% become chronic carriers • 5-10% of those advance to liver disease • Hepatitis B Vaccine is available to prevent disease

  40. Hepatitis C (HCV) • Symptoms same as Hepatitis B • Antibodies may not provide immunity • Up to 85% will develop chronic hepatitis • 3.9 million chronically infected in US • Sexual transmission uncertain

  41. Respiratory etiquette to prevent transmission • Cover your cough or sneeze • Deposit tissues directly into the trash • Clean hands after use of tissues or cough/sneeze • Offer tissues or mask to others with coughing or sneezing • Remind them to clean hands

  42. Infection Control is Everyone’s Responsibility!

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